The Art of Diagnosis

Teaching Medical Students to Keep Their Eyes Open

By Matt Windsor

Art appreciation is helping UAB medical students get a better picture of patient health. In a weeklong course taught by UAB internist Stephen Russell, M.D., at the Birmingham Museum of Art, students learned to look for important visual cues—and clues—in paintings and other works.

As patients go, the African “power figure” on the second floor of the Birmingham Museum of Art is a lost cause. No innovative procedure or sophisticated new test can bring him to life. But the UAB medical students staring hard at the sculpture one afternoon last fall were still hoping to learn something. So one by one, they got out their pencils and started to draw.

The students were taking part in a weeklong course called Art in Medicine, developed by UAB internist Stephen Russell, M.D., as part of the School of Medicine’s Special Topics series. Russell, who practices internal medicine and pediatrics at UAB Health Center Moody outside Birmingham, was conducting something of an experiment: Could learning to appreciate art make his students better doctors?

"We wanted the students to learn how to sit still, look, and listen. You're always going to be rushed in the practice of medicine.... If you sit down and listen, you'll learn a lot more.”

Evidence from the medical school at Yale University suggests that it can. Irwin Braverman, M.D., a Yale dermatologist, began taking students to an on-campus art museum in 1998 to improve their observation skills. Several studies by Braverman and others suggest that students are significantly more sharp-eyed after taking the course.

Russell read about Braverman’s work in TheNew York Times and decided to pilot a similar class at UAB. He contacted Braverman and obtained permission to use his collection of art images for a pre- and post-test to gauge student improvement. “Students at this stage believe there are ready answers to all of life’s questions,” says Russell. “I know I was that way in medical school. We wanted to show them that reflection is important.”

Stop, Look, and Listen

Over the course of a week, the UAB students gathered in a museum meeting room to discuss assigned readings and take part in group exercises. The most popular was called “Private Eye,” says Russell. “The students had to look through a jeweler’s loupe at various objects—a beetle, a piece of quartz, a toy—and draw a picture based on what they saw. It was all designed to see how much they could observe.”

The students spent their afternoons in the museum’s galleries, honing their powers of observation on portraits, sculptures, and other artworks.

“We wanted the students to learn how to sit still, look, and listen,” Russell says. “You’re always going to be rushed in the practice of medicine. But your posture is important. Many times you’re standing, writing prescriptions while the patient is talking, maybe thinking about the patient in the room you just left. If you sit down and listen, you’ll learn a lot more.”

Seeing Things

A physician, like an artist, must always be on the alert for visual cues—and clues—says Russell. “When you are making decisions, you can get 90 percent of what you need from your experience and training, but it’s that critical last 10 percent that can keep you from understanding the meaning of an artwork or the correct diagnosis in medicine,” he says. “This class is about working on that 10 percent.”

Students learned to look at “each painting like a case,” says fourth-year Merrill Stewart, who has an undergraduate degree in fine arts and is planning on a career in internal medicine. His favorite “patient” was “The Sorceress” by George Merle, “a picture captivating for the intense gaze and mystery surrounding the subject.”

The class was a “wonderful way to explore the art of observation, revisiting some of my art history past and applying it to my current profession,” Stewart says. “Too quickly we jump to tests and scans in medicine without taking adequate survey of the scene before us,” he says. “While those tests and scans might ultimately be needed to provide the best level of care, without taking stock of your visual impression, you are essentially leaving out one key test—and often the most important and least expensive one.”

In the future, Stewart says, “I will place a greater emphasis on the initial observation and make note of clues I can glean that can add to the greater picture.”

Fellow fourth-year student Mary Catherine Laney intends to spend her career studying pictures as a radiologist. But she says the Art in Medicine course helped her take a new approach to patients as well. “There is so much more to the patients we see than just their ‘chief complaint,’” says Laney. “They need to be studied like a work of art in order to be treated effectively and efficiently. What meets the eye can appear different to different people, and I will try to keep an open mind when dealing with patients and other health-care professionals.”

Look Again

After a successful trial run in October, Russell added an even longer section of art training to the syllabus of Master’s in Physical Diagnosis, an elective course offered each February to 15 students about to graduate from the School of Medicine.

Russell says that pondering the lessons of art has helped him become a better doctor as well. “For me, this course helps to identify the areas of medicine that fall between good intentions and good execution so that I can avoid the pitfalls and shadows that lead to erroneous diagnoses and errors in judgment,” he says. “Unquestionably, my own ability to look and listen has improved by facilitating this course.”